Iimori Kei, Tanaka Yasuyuki, Fujii Shigehiko, Shibuya Shinsuke, Kusaka Toshihiro
Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, 17, Yamada Hirao-Cho, Nishigyo-ku, Kyoto, 615-8256 Japan.
Department of Diagnostic Pathology, Kyoto Katsura Hospital, 17, Yamada Hirao-Cho, Nishigyo-Ku, Kyoto, 615-8256 Japan.
Int Cancer Conf J. 2021 Oct 25;11(1):62-66. doi: 10.1007/s13691-021-00518-7. eCollection 2022 Jan.
A 73-year-old man was initially diagnosed with a 50-mm, depressed-type early gastric cancer on the anterior wall of the angulus, and the lesion was curatively resected en bloc by endoscopic submucosal dissection. Pathology revealed a 54 mm × 43 mm differentiated-type predominant adenocarcinoma with focal undifferentiated-type component that was confined to the mucosa without ulceration. Eleven years after endoscopic submucosal dissection, lymph node metastasis along the lesser curve was incidentally detected on magnetic resonance imaging and diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy. The patient received distal gastrectomy with D2 lymph node dissection. A resected lymph node revealed a well-differentiated adenocarcinoma with a poorly differentiated component; thus, the final diagnosis was late recurrence of early gastric cancer originally treated by endoscopic submucosal dissection. This report demonstrates that metastatic recurrence may occur in curative endoscopic submucosal dissection for early gastric cancer and that gastric cancer can recur even after more than 5 years.
一名73岁男性最初被诊断为胃角前壁有一个50毫米的凹陷型早期胃癌，该病变通过内镜黏膜下剥离术整块切除治愈。病理显示为一个54毫米×43毫米的以分化型为主的腺癌，伴有局灶性未分化型成分，局限于黏膜层，无溃疡。内镜黏膜下剥离术后11年，磁共振成像偶然发现沿小弯侧有淋巴结转移，并通过内镜超声引导下细针穿刺活检确诊。患者接受了D2淋巴结清扫的远端胃切除术。切除的淋巴结显示为一个高分化腺癌伴有低分化成分；因此，最终诊断为最初经内镜黏膜下剥离术治疗的早期胃癌晚期复发。本报告表明，早期胃癌内镜黏膜下剥离术根治性切除后可能发生转移性复发，且胃癌甚至在5年以上仍可复发。
